Facelift

A facelift, also known as rhytidectomy, is a type of cosmetic surgery that lifts and tightens the skin on the face. It focuses on the lower half of the face and can help reduce sagging skin and smooth deep folds around the cheeks and jawline. 

A neck lift is sometimes performed at the same time to tighten the skin around the neck. 

Why have a facelift?

As we get older, it's normal for the face to change. Skin loses elasticity, fat in the face can shift downwards, and some areas — especially the lower half — can gain some unwanted fat.

This can lead to changes in our appearance:

• A double chin
• Deep lines between the nose to the mouth (the nasolabial folds) and chin (marionette lines)
• Loose skin along the jawline (jowls)
• Sagging skin

Losing a significant amount of weight can cause similar changes.

A facelift is a surgical procedure to lift, tighten and smooth the skin, helping to restore a more defined facial shape.

Is a facelift right for you?

A facelift may be suitable if you have sagging skin but still good skin elasticity and a well-defined bone structure. Most people who have this surgery are in their 40s to 60s but it may still be an option if you’re older and in good health.

It may not be suitable for you if you have certain medical conditions, such as poorly controlled diabetes or high blood pressure, which can affect wound healing.

A facelift focuses on the lower half of the face. If you’re more concerned about sagging eyebrows or forehead lines, your surgeon may recommend a brow lift instead or in combination with a facelift.

It’s important to have realistic expectations. Most people are happy with the results, but it can take time to adjust to your new appearance. Recovery is gradual and it may take 6–9 months to see the full effects.

Your consultant will explain the benefits, risks and recovery, so you can decide if this is the right option for you. 

What are the intended benefits from this procedure?

A facelift can help:

• Lift and tighten the skin on the face
• Remove excess skin that causes sagging or jowls
• Smooth deep lines around the nose and mouth, such as the nasolabial folds and marionette lines

Alternative treatments to a facelift

Facelift surgery is often the most effective way to tighten facial skin, but there are non-surgical options:

• Botulinum toxin (Botox) injections — to smooth wrinkles on the forehead, around the eyes and the mouth
• Laser surfacing (where a laser is used to burn the top layer of the skin) or chemical peels (where a chemical is used to peel off the surface of the skin) — to improve the skin texture 
• Fat grafting or lipofilling — using fat from another part of the body to restore facial volume

Other types of surgery can be performed at the same time as a facelift, such as a brow lift to raise sagging eyebrows or a neck lift to tighten skin of the neck.

Your surgeon will discuss the best options for your goals and needs.

A facelift involves raising and repositioning the skin and soft tissues of your face to help tighten and smooth the lower facial area.

There are several techniques used and your surgeon will explain the best approach for your needs. The operation typically involves:

• Making cuts above the hairline at the temples, extending down in front of the ear, underneath the earlobes, behind the ear and into the lower scalp
• Making cuts under the chin if the jawline is being lifted
• Distributing facial fat and soft tissue or adding fat to the face
• Removing excess skin
• Gently pulling the skin backwards and upwards and stitching it into place

After surgery, your face will be bandaged to help reduce bruising and swelling and support your healing.

How to prepare for your procedure

If you’re thinking of having a facelift, make an appointment to discuss it with a surgeon. They’ll ask about your reasons for having surgery and what results you want to achieve. They’ll also review your medical history and any medication you take to ensure surgery is suitable for you. Make sure to tell them about all medicines, including herbal remedies and anything bought over the counter.

The surgeon will examine your face and may take some photographs. It’s important to ask questions so you understand the procedure, potential risks and how to care for yourself afterwards. Attending all required appointments helps your care team provide the best possible care.

You’ll be asked to sign an informed consent form before going ahead with surgery. Informed consent means that you understand the procedure, its risks, expected outcomes, post-operative care instructions and alternative options, as explained to you by your care team.

It helps to be as healthy as possible before surgery by maintaining a healthy weight, following a balanced diet and taking regular exercise. If you’re overweight, your surgeon may recommend delaying surgery. Other recommendations before surgery include:

• Avoid taking aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for at least 2 weeks before surgery to reduce the risk of bleeding — your surgeon will advise you
• Colour, perm or bleach your hair at least 1 week before your operation if needed
• Stop smoking at least 6 weeks before surgery

Make sure to shower 24 hours before surgery to keep the area clean. There’s no need to remove any hair near the areas where the cuts will be made. You’ll need to stop eating and drinking (ie to fast) for a few hours before surgery — your admission letter will include full instructions.

Who will be involved?

Your operation will be carried out by a specialist plastic surgeon who will be registered with the General Medical Council (GMC). A consultant anaesthetist will give you the anaesthetic and monitor you throughout the procedure. Specially trained nurses and recovery staff will look after you before, during and after your surgery. 

How long does the procedure take?

The operation usually takes between 2–5 hours.

Anaesthetic choices

A facelift is usually performed under a general anaesthetic, so you will be asleep and won’t feel anything during the procedure. In some cases, it may be done under local anaesthetic with sedation, where the whole area is numbed.

Pain during surgery and straight after surgery

You won’t feel any pain during the operation, as you’ll be under an anaesthetic — either general or local. After surgery, it’s normal to experience some swelling, bruising and pain, but you’ll be given pain relief to help manage this. Make sure to take any medication as instructed by your care team.

What happens straight after surgery

Your surgeon will apply dressings to your face to reduce swelling and bruising. You may also receive antibiotics to help prevent infection to the wound. You may have some small tubes to drain any fluid or blood.

Your hospital stay

It’s likely you’ll need an overnight stay at the hospital, so your recovery can be closely monitored.

Recovery time

Most people recover from facelift surgery within 2–4 weeks. Bruising often lasts at least 2 weeks and it can take several more weeks for scars and changes to your skin colour to fade. It takes 6–9 months to see the full results of the facelift.

Short term side effects

After facelift surgery, it’s common to experience some side effects as your body begins to heal. These usually improve within a few weeks and may include:

• A feeling of tightness in your face and mouth — this usually goes away in around 6 weeks
• Bruising in the face — this can last for a few weeks
• Feeling low for a few days
• Pain
• Scars — these should fade with time
• Swelling and numbness around your face — this can last for weeks or months

Your surgeon will give you specific advice on how to care for your skin and what to expect during recovery.

After the operation

You’ll have some swelling and bruising in your face. To help reduce swelling, keep your head raised — use extra pillows for the first few days. You should be able to get out of bed and move around on the same day of your surgery.

Any drainage tubes are usually removed within a couple of days. It’s also normal to have some numbness in your cheeks or ears, which usually improves over the following weeks or months.

Most people can return to light activities around 2 weeks after surgery.

Wound care/dressings

Your face will be bandaged after surgery and you’ll usually need to keep the bandages on for the first 2 days. It’s important to keep them dry.

Stitches are typically removed after 7–14 days, unless dissolvable stitches are used — these will gradually disappear on their own. Follow your care team’s advice carefully on how to look after your wounds after surgery.

Pain relief

It’s normal to have some pain after the operation, but pain relief such as paracetamol can help manage this. Your care team will advise you on what to take and when.

Smoking

Smoking or using nicotine vapes reduces blood flow to the skin and increases the risk of complications, such as poor healing, haematomas (a pool of collected blood under the skin) and skin loss after surgery. It’s important to stop smoking at least 6 weeks before surgery and avoid it during your recovery.

Driving

You’ll not be able to drive for several days following the operation. Your surgeon will advise you on this.

Time off work

You’ll need around 2–4 weeks off work to recover from facelift surgery.

How your loved ones can help

When you’re ready to go home, you’ll need to arrange for a friend, family member or taxi to take you, as you won’t be able to drive. It’s also a good idea to ask someone to help with everyday tasks like shopping, as you’re unlikely to feel up to these in the first few days.

What you should/shouldn’t do after surgery

Following surgery, make sure to:

• Avoid bending down or having sex for at least 2 weeks
• Avoid lifting anything heavy for at least 2 weeks
• Avoid showering and getting your bandages wet for the first 2 days
• Avoid vigorous activity, saunas and massages for at least 2 weeks
• Follow your care team’s advice on how to look after your wounds
• Maintain a healthy weight, follow a balanced diet and take regular exercise

Things you can do to help with recovery

To help support your recovery:

• Avoid smoking
• Attend your follow-up appointments
• Eat a healthy, balanced diet
• Protect your skin from the sun
• Rest — avoid strenuous activity for at least 2 weeks
• Sleep with your head raised — this helps reduce swelling

It’s also important to follow your surgeon and care team's advice to help with your recovery.

When can you resume normal activities?

You can usually return to work and to your normal activities within 2–4 weeks of having surgery.

When will I see the results?

It can take 6–9 months to see the full results of your facelift, as healing takes time. While most people are happy with the outcome, it can take a little while to adjust to your new appearance. Results aren’t guaranteed, but your surgeon will help you set realistic expectations.

As with any surgery, a facelift carries some risks. A facelift can sometimes result in problems, such as:

• Asymmetry in facial features
• Bruising, swelling and pain
• Nerve injury and loss of movement in the face
• Numbness or changes sensation — this is often temporary, but can be long term
• Scarring or skin discolouration
• Unsatisfactory results, sometimes needing further treatment

Any type of surgery carries a small risk of:

• Allergic reaction to the anaesthetic, which can cause swelling, difficulty breathing, feeling faint or dizzy
• Blood clots in a vein, which can cause pain, redness and swelling
• Excessive bleeding
• Infection — signs include pain, swelling, redness, pus at the wound, chills or a high temperature

Your surgeon will explain how likely these risks are and how they can be treated if they happen. They will also answer any questions you have.

Choosing a consultant surgeon

If you’re considering a facelift, it’s important to choose a surgeon who’s experienced in plastic surgery. They should be registered with the General Medical Council (GMC) and listed on the GMC’s specialist register for plastic surgery.

All Spire Healthcare plastic surgeons are highly experienced and registered with the GMC.